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GP practices to catch up on public health targets post-Covid or risk LES income

by Caroline Price
29 June 2020

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GP practices in Essex have been told they will have to catch up on targets for NHS Health Checks once the service is re-established post Covid-19, or they could face having payments clawed back.

Anglian Community Enterprise, which procures the service on behalf of the local authority Essex County Council, informed practices by email they would be paid monthly based on 2019 activity until the end of June, but that targets for the year would need to be met ‘once in more certain times’.

The message, seen by Pulse, stated: ‘We recently wrote to you explaining the current financial situation on which we are paying all providers based on the NHS Health Check delivery performed in April, May and June 2019.

‘Payments will made month by month as normal. However, targets will be remaining the same for this financial year and will be expected to be met once in more certain times.’

The LMC told Pulse it was in discussion with Essex County Council, and that the Council was ‘aware’ of concerns about the extra workload and loss of income this might impose on practices.

Dr Brian Balmer, Essex LMC medical secretary, said: ‘We have raised this with the local authority, who are generally primary care friendly, and it will require further discussion on whether what has been planned is possible. They are aware of the issues.’

An Essex County Council spokesperson said: ‘We don’t want to see our GP colleagues disadvantaged during these difficult times so have proposed to pay GP Providers for April, May and June based on the amounts they were paid for activity in 2019.

‘This will be paid as an advance payment. We will review this position later in the year when we will hopefully have more clarity on what activity could be provided. We will continue to work closely with our colleagues throughout this time.’

It comes as practices in other areas have also found they are not guaranteed usual income for public health services commissioned by local authorities, such as contraception and NHS Health Checks, where those services have had to be put on hold due to Covid-19.

In Kent practices are being paid 80% of their 2019 payments for contraception, NHS Health Checks and smoking cessation LESs, based on historical activity.

Kent LMC Medical Secretary Dr John Allingham told Pulse practices had yet to be paid for NHS Health Checks and smoking cessation, ‘as they are sub-contracted through our community trust, but we have the agreement’.

Dr Allingham said the agreement had received a ‘mixed response’ from practices as ‘some feel it should have been 100%’.

Kent County Council told Pulse: ‘The Council’s decision to provide a supplier relief payment was formed from the Cabinet Office’s ‘Procurement Policy Note – Supplier relief due to COVID-19’.

’Working in collaboration with the Kent LMC and other local authorities to consider their views, service costs, service risks and the Cabinet Office advice an agreement was reached

‘The agreement of 80% recognised that usual funding arrangements include non-staff costs which would not be incurred during non-delivery. It therefore provided the continuation of cash flow to GP surgeries while also allowing the Council to retain funding to meet latent demand for these services and to fund alternative provision to meet service gaps caused by the pandemic.’

How GP practices should be paid for public health LESs during Covid-19 

NHS England informed practices in March that their income from non-routine work, including LES money, would be protected so they could focus on dealing with the Covid-19 emergency.

It stated: ‘Unless commissioned services are considered to support the national COVID-19 response, LES/LISs, local pilots, regional or nationally commissioned pilots should cease, based on local discretion. Funding, particularly to support staffing, should be maintained and re-directed to the primary medical care COVID-19 response.’

A Government directive issued the same month instructed local authorities and other public bodies (including NHS commissioners) to pay suppliers (including GP practices) until ‘at least the end of June’.

The Policy Procurement Notice from the Cabinet Office stated that all contracting authorities should:

  • inform suppliers who they believe are at risk that they will continue to be paid as normal (even if service delivery is disrupted or temporarily suspended) until at least the end of June.
  • Put in place the most appropriate payment measures to support supplier cash flow (including payment in advance/prepayment or interim payment).

It also notes that ‘other forms of relief (such as relief from performance indicators and delayed targets) should be considered’.

However, the notice also states that ‘being in receipt of an advance payment does not excuse the supplier from their contractual obligations to deliver’ and that ‘the payments made under PPN 02/20 are for continuity and retention; the supplier must deliver in full when required by the contracting authority’. 

And supporting FAQs explain: ‘In some cases the goods, services or works paid for during this period may be required to be delivered at a later date. In some cases, and following reconciliation of payments made, the contracting authority may consider a future claw-back of monies paid where delivery will not be made in the future.’

In a statement to Pulse, Councillor Ian Hudspeth, Chairman of the Local Government Association’s Community Wellbeing Board, said: ‘Councils as local commissioners are fully aware of the extra challenges faced by GPs and are working closely with them during this difficult period. Directors of Public Health, working in councils, are negotiating with GPs in their communities to ensure the best solution for each area.

‘Councils can and do agree with GPs about what they need in terms of planned payments to help them through the coronavirus crisis. Contracts between councils and GPs are often activity based, therefore a pure rollover in some areas will be possible, but not in others.’